Individual
BRANDY B CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11927 SONORA SPRINGS DR, TOMBALL, TX 77375-1760
(832) 298-9095
(281) 310-6576
Mailing address
PO BOX 682781, HOUSTON, TX 77268-2781
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
385H00000X
—
TX
Enumeration date
07/17/2020
Last updated
07/17/2020
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